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Title: Cardiovascular risk prediction in Central and Eastern Europe and former Soviet Union
Author: Vikhireva, O.
ISNI:       0000 0004 2734 0726
Awarding Body: University College London (University of London)
Current Institution: University College London (University of London)
Date of Award: 2012
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SCORE scale assesses the risk of fatal atherosclerotic cardiovascular disease (CVD), based on traditional risk factor levels. The high-risk SCORE version is recommended for Central & Eastern Europe/former Soviet Union (CEE/FSU). The aim of the thesis was to evaluate SCORE performance in CEE/FSU, using evidence from two large CEE/FSU studies. These studies – MONICA and HAPIEE – include cohorts from CEE/FSU countries which have relatively high but heterogeneous CVD mortality. MONICA subjects were followed for >=10 years from the mid-1980s. Ongoing HAPIEE follow-up (baseline 2002-2004) allowed preliminary assessment of SCORE performance in contemporary CEE/FSU settings. The present study included Czech, Polish-Warsaw, Polish-Tarnobrzeg, Lithuanian, and Russian MONICA samples (n=15,027), plus Czech, Polish, and Russian HAPIEE samples (n=20,517). Predicted 10-year CVD mortality was calculated with high-risk SCORE; observed mortality data came from local registers. While SCORE calibration was good in most MONICA samples (predicted to observed (P/O) mortality ratios approached 1.0), mortality risk was under-estimated in Russian men and women. In Cox regression analysis, SCORE >=5% significantly predicted 10-year CVD mortality: hazard ratios (HR) ranged from 1.7 to 6.3. The shorter HAPIEE follow-up meant that P/O ratios exceeded 1.0. These ratios were 2-3 times higher in Czech and Polish vs. Russian participants. Estimates of 10-year HAPIEE mortality confirmed this gap between Czech and Polish vs. Russian samples. SCORE significantly predicted CVD mortality in each HAPIEE sample (HR 2.6-10.5). Values of Harrell’s C-statistic, a summary discrimination measure, reached 0.6-0.7 in MONICA and HAPIEE. Adding socioeconomic parameters or alcohol consumption characteristics to the SCORE model failed to improve its predictive performance. High-risk SCORE discrimination was satisfactory in most MONICA and HAPIEE samples, despite risk under-estimation in Russian MONICA. HAPIEE data suggest that in contemporary Czech and Polish populations, high-risk SCORE might over-estimate CVD risk. SCORE extension by additional predictors did not improve its performance.
Supervisor: Pikhart, H. ; Bobak, M. Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available